995 Cavernous Sinus Thrombosis Secondary to Dental Neglect

Abstract

Abstract Background Cavernous sinus thrombosis is a rare, potentially life-threatening condition often caused by a cervicofacial bacterial infection. Prompt diagnosis and management improve prognosis and help prevent permanent complications. Clinical case A 54-year-old man with a background of alcohol excess attended the emergency department following a collapse at home. He presented with a potassium of 1.5 and a firm right parotid swelling with associated facial nerve weakness and was admitted to ICU for management of severe sepsis and electrolyte disturbance. CT imaging out of hours showed swelling of right parotid and submandibular areas and generalised oedema parapharyngeally. Further clinical examination by the maxillofacial team noted a right sided 6th nerve palsy, raising concern about intracranial spreading infection from a dental source and MRI was requested. The patent continued to deteriorate and developed bilateral chemosis and proptosis. MRI scan confirmed bilateral cavernous sinus thrombosis and right cerebral hemisphere subdural collection and the patent was transferred to a neurosurgical unit for a craniotomy, temporal lobe washout and dental clearance. Upon further review of imaging by a specialist head and neck radiologist the cavernous sinus thrombosis was noted on the initial scans. Conclusions Raise awareness of this condition and its management – much rarer more now due to antibiotics in developed world. Importance of thorough clinical examination to pick up subtle signs such as cranial nerve palsies. Vital to have multidisciplinary involvement in diagnosis and management; both radiology to help with diagnosis and neurosurgery, ENT and maxillofacial to carry out surgery as required.